B) Who Provides Care?
Often, family members are able to care for their elders. However, there are many cases where family members cannot provide care (e.g., because they live far away, or have other critical responsibilities), or should not provide care (e.g., because the elder has medical care or supervision needs the family cannot reasonably accommodate). There are also cases where family members do not want to provide care for whatever reason. In such cases, professional care providers should be enlisted to help provide for elders' care needs. The following discussion provides descriptions of the various types of professional medical and mental health elder care specialists that may be available to provide care in your area.
- Registered nurses have graduated from a three-to four-year accredited nursing program and will have undergone supervised clinical experiences. They have passed a state examination and have been licensed by the state. RNs may specialize or become expert in providing particular kinds of care, including geriatric care, hospital care, nursing home care, public health services, occupational care, or supervisor and management administrative positions. As medical professionals, RNs are able to dispense medications, monitor elder's vital signs and provide fairly extensive medical care services, provided those services have been previously authorized by a doctor. Some RN nurses will have completed an advanced degree, qualifying them as Nurse Practitioners. Nurse Practitioners have more autonomy to act than do regular RNs, and may be able to take responsibility for elders' medical care to a much greater degree than a regular RN.
- A licensed practical nurse (LPN) has completed a two year college degree, rather than the three-to-four year degree characteristic of the RN. LPNs are licensed by the states to work under the supervision of an RN or physician to provide basic bedside care such as taking vital signs (temperature, blood pressure, etc.), dressing and caring for wounds, and bathing and dressing assistance. LPNs are commonly employed in nursing home environments where they monitor patients and report back regularly to their supervising RN. An LPN working in a nursing home may also help to develop care plans and keep detailed records of care provided. An LPN working in an elder's own home can provide basic medical care for the elder, and teach family members how to provide basic eldercare. LPNs in private employment as eldercare workers may be available to assist elders with activities of daily living such as meal preparation.
- Nurses' aides provide basic care and services. A certified nursing assistant (CNA) usually has some schooling or on-the-job training and then takes a certification class through a community college or technical school. They most often work in nursing homes and hospitals, but may also be available to provide in-home care. Their duties will usually include checking in on patients, helping them in and out of bed, and making beds.
- Medical doctors (MDs, otherwise known as physicians) diagnosis illness and prescribe medications and treatments. They receive a four year college degree, attend four years of professional medical school, and then complete a multi-year supervised residency prior to their becoming licensed by the state to practice medicine. Medical doctors are responsible for diagnosing and properly treating illnesses. They write orders for specific types and schedules of care which nurses then carry out.
Like other professionals, medical doctors frequently specialize. An Internist is a type of MD who has specialized in treating diseases of the internal organs (including the kidney, liver, and digestive system, etc.). Geriatric medicine specialists, also known as Geriatricians, are family medical doctors or Internists who specialize in the diagnosis and treatment of the elderly.
- Neuropsychologists are doctors of clinical psychology (usually holding the Ph.D. degree) who have specialized in diagnosing subtle brain and behavioral problems. They complete a four year college degree, attend four to six years of professional clinical psychology school, complete a year-long supervised pre-doctoral internship, and then an additional year of supervised postdoctoral clinical work prior to their being licensed by the state to practice psychology. Neuropsychologists use a variety of psychological tests and assessment devices, including tests of intelligence, cognition (attention, memory, and judgment), and personality to tease out subtle brain or neurological impairments that cannot be otherwise measured by even the most sensitive brain scanning devices. Neuropsychological tests are commonly used to identify pseudodementia, and dementia conditions, or to determine what subtle functional abilities may have been lost in the aftermath of an elder's stroke.
- Social workers are helping professionals who attend to the social aspects of care giving. These professionals will evaluate the elder, advise on care needed, help create a care plan, advocate for the elder, and link him or her to needed resources. Many social workers also function as therapists and counselors, helping elders and their families to cope with problems and issues. Social workers are state licensed professionals who have completed a four year college degree at a minimum; most have masters degrees (such as the MSW). They will have completed supervised clinical experiences as part of their training prior to practicing independently.
- Occupational therapists are state-licensed helping professionals who help disabled elders (and other patients) to adapt to changed or diminished circumstances by learning new ways to manage activities of daily living, and to develop new skills necessary to help them have a reasonable quality of life. In pursuit of these goals, they will work with patients to rehabilitate or adapt lost physical, cognitive, or sensory functions, or social skills so as to promote maximum patient independence. At minimum, they complete a four year college degree prior to licensure by the state. Many have also completed masters degrees as well.
- Physical therapists are state-licensed professionals who work with patients to restore physical body function and mobility that have been lost due to injury or physical disability. They also help patients with pain management. They get patients to exercise, and will use electrical stimulation, ultrasound and massage as well so as to help patients better recover range of motion, strength, and flexibility. Physical therapists will have completed a four year college degree at a minimum, and most will have also completed a specialized physical therapy masters degree.